Bullous Pemphigoid (BP) is a rare, autoimmune disease featuring inflammatory blisters in the sub-epidermal part of the skin. It is chronic in nature and can persist for months or years, with a tendency to spontaneous remissions and exacerbations.
It is not to be confused with another similar sounding disease, Pemphigus vulgaris (PV). While both are autoimmune diseases targeting the skin, PV is comparatively more common, is limited to the upper epidermis, involves the mucous membrane more often, blisters rupture easily, and it has a higher fatality rate. In comparison, BP is located between the dermis and epidermis, the tense blisters do not break easily, mucous membrane involvement is much lesser, and it is more amenable to treatment, though it too can be fatal in the elderly or debilitated people. The diagnosis can be confirmed in both diseases using skin biopsy for Direct Immunoflourescence test (DIF) and Indirect Immunoflourescence test (IDIF) using serum. While autoantibodies desmoglein 1 and 3 denote PV disease, the presence of anti-BPA 1 and 2 confirm a diagnosis of BP.
The standard treatment of BP includes the use of anti-inflammatory drugs and immune suppressants, to reduce and heal blisters and erosions and to prevent recurrence with continued use of the minimum possible dosage of medicines. Anti-inflammatory drugs include corticosteroids, tetracycline and dapsone, while immune suppressant drugs include azathioprine, methotrexate, mycophenolate mofetil and cyclophosphamide. Doxycycline has been found to be more effective and with lesser adverse effects as compared to prednisone. Most patients experience long term remission with about 6-60 months of treatment.
Most of the mortality associated with BP is due to the adverse effects of long term use of drugs used for treatment. Steroids can aggravate hypertension, heart disease, diabetes, peptic ulcer, and bone thinning. Since BP primarily affects elderly people, most patients already have such diseases as comorbidities. Localized skin involvement can be treated using potent topical corticosteroid ointments along with anti-inflammatory medicines so as to avoid the side effects of oral steroid therapy. Refractory patients may benefit from biological treatment with Rituximab.
Ayurvedic herbal medicines have a definite role to play in the management of BP since the treatment is safe for long term use, and can effectively provide prolonged or permanent remission from the disease. While it has been discussed above that BP is completely different from PV, since the part of skin involvement is different in both diseases, the Ayurvedic treatment guidelines and protocol for both diseases is more or less the same. This is because, till date, there is no different treatment approach based upon the different layers of affected skin.
Ayurvedic herbal treatment for BP involves the use of herbal medicines which have a direct action on skin, subcutaneous tissue, capillaries, blood, and blood vessels. Since this is an autoimmune disorder, treatment is aimed at managing inflammation, allergy, chronic infection, detoxification, strengthening and rejuvenation of faulty or dysfunctional tissue, and gradual modulation of immunity. As the disease gradually moves into a remission phase, follow up treatment includes the use of generalized rejuvenation of the full body, also known as Rasayana therapy. For better prevention, those herbomineral formulations are used which not only activate healthy body metabolism, but also simultaneously provide control for inflammation, allergy, and help gradually build up true body immunity.
Patients who do not respond adequately to simple oral herbal therapy, or those with severe involvement at presentation, are subjected to systematic detoxification plans known in Ayurveda as Panchkarma. These may be given singly or in combination, as per the discretion of the attending physicians. Caution needs to be exercised while doing detoxification procedures, since BP is mainly found in the elderly population. For recurrent, localized skin involvement, simple blood-letting from a vein near the affected parts, or leech application in several sittings may provide dramatic results at almost no risk.
Local application of herbal ointments along with a few oral herbs may provide benefit to most patients affected with BP. Ayurvedic herbal treatment for about 6-8 months is usually sufficient in providing long term remission to most patients who approach physicians for Ayurvedic treatment. Severe autoimmune involvement may require aggressive treatment for nearly 18- 24 months. The presence of comorbidities may additionally prolong treatment. Most affected people with BP usually get significant relief and lasting remission with Ayurvedic herbal treatment.
The writer, Dr A A Mundewadi is available as an Ayurvedic Consultant at https://www.mundewadiayurvedicclinic.com and http://www.ayurvedaphysician.com
